| NPI | 1831274323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 188) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OK 188) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2015-06-16 |